It’s time for the UK to rethink its approach to medical cannabis

Producing and exporting the most amount of medical cannabis in the world – why is medical cannabis still being denied to patients in the UK?

With the UK recognised as the largest producer and exporter of legal cannabis in the world, we may think that the advances in medical use and science would also be world-leading, but nothing could be further from the truth. LEAP UK’s Jason Reed highlights the need for common sense drug policy reform regarding medical cannabis.

The International Narcotics Control Board (INCB), a UN body, found in a report that the UK produced 95 tonnes of cannabis in 2016, nearly 50% of the world’s total, and exported 2.1 tonnes – roughly 70% of the world’s total.¹ All of this production is under the guise of ‘medical and scientific’ use.

Are UK drug policies fit for purpose?

As most campaigners within UK drug policy reform will attest, these figures draw attention to some rather glaring hypocrisies. The UK still has a drug policy which is based on the UN’s Single Conventions on Narcotic Drugs 1961, which essentially means that all drugs are ‘controlled’.² In real terms this means that the UK operates under a policy of absolute prohibition of all drugs, barring alcohol and tobacco, and any possession or production of illicit substances comes with a criminal penalty.

Even those who use cannabis for medicinal purposes are not exempt; those who provide anecdotal evidence that cannabis may help alleviate the symptoms of multiple sclerosis (MS), myalgic encephalomyelitis, fibromyalgia, Crohn’s disease, Parkinson’s disease, cancer, and many other health conditions are still in harm’s way of receiving serious legal repercussions from possessing the substance. As yet, the UK has not followed examples in North America, Israel, and many parts of Europe, in allowing those with serious health conditions to consume cannabis legally.

The UK’s drug classification and scheduling system has fully prevented advances in science and medicine.³ As it currently stands, cannabis is a schedule 1 drug, meaning there is no therapeutic value and only tightly controlled research under UK Home Office licence is permitted. Those in the scientific field have long balked at such claims and restrictions. The rather perverse nature of the scheduling system also means that successive UK governments have repeated the line that cannabis has no medical value, overlooking any such irony that their own policies are the ones restricting access and research. The latest finding that the UK produces and exports the most amount of cannabis in the world for medical and scientific purposes certainly makes a mockery of any patient’s plight, and the scientific community is increasingly becoming vocal about the farce that we now find ourselves in.

If this wasn’t bad enough, there are financial interests which have poured salt on many open wounds amongst those who are pleading with their government ministers for legal access.

Victoria Atkins MP, Parliamentary Under Secretary of State at the Home Office, a role often dubbed as the ‘drugs minister’, has been found to have a conflict of interest to such a degree that she is no longer able to answer questions on the matter, despite still holding the office. Atkins’ husband is the managing director of British Sugar, which is essentially licensed to grow cannabis in an 18-hectare glasshouse. It doesn’t stop there either.

The Prime Minister of Great Britain, Theresa May, also has financial ties to the UK cannabis industry, with her husband Philip May’s company, Capital Group, being the largest investor in GW Pharmaceuticals, the company which is growing cannabis for medical purposes. GW Pharmaceuticals has produced Sativex, a tincture in the form of an oral spray for use in spasticity control, and its latest cannabis-based drug is Epidiolex, a medication intended to help with epilepsy.

How has the Home Office reacted?

In recent months the UK has seen high-profile cases in the media of children who suffer with severe and rare forms of epilepsy, leading to incredibly distressing seizures. Two families hit the headlines: Billy Caldwell and his mother Charlotte, and Alfie Dingley and his mother Hannah Deacon. Both families had to leave their home country to obtain cannabis-based medicines which they report have had an overwhelmingly positive impact on their children’s ongoing health conditions.

The problem arose when trying to access these medicines when back in the UK and, indeed, when trying to re-enter the UK. Due to rather large public interest and pressure, the Home Office granted temporary and special licences to these families and, in doing so, opened a hornet’s nest within the civil service. The question was asked: how can cannabis officially have no medical value and yet the Home Office is now granting special provisions for families to obtain access? This in turn led to more questions from rightfully angry patients and their families.

Since these high-profile cases, the Home Office has floundered in coming up with a suitable system to grant other families access to cannabis. Due to the sheer volume of cases now coming forward, the Home Office had to react and it did so by setting up what it termed an ‘expert panel’ designed to take a case-by-case look at those requesting access to cannabis medications.⁴ Unfortunately, since the two preceding high-profile cases, to date, no other licences have been granted, which has called into question the validity and sincerity of such a system.

What should reform look like?

Those who are involved in the campaigns to reform medical cannabis laws are varied and often have differing ideas as to how reform should look. Some believe that tightly controlled systems, such as the one hastily set up by the Home Office under public pressure, are on the right lines but need more tweaking to get them to function correctly. Others see these restrictive systems as too much and are advocates of looking at other medical cannabis models from across the globe.

There’s an inherent risk that opting for tightly controlled models of reform would mean a prohibition of cannabis for those who need it simply through reams of red tape. As we’ve seen in recent months, the UK now has a quasi-medical cannabis system, but access is denied for the majority of people. The expert panel was designed to assess each case where other medications have failed and to make suitable provisions based on the available evidence.

Unfortunately, this has meant that those who have campaigned for many years to have access to cannabis have been excluded and no access has been granted. Looking forward, we must ensure that an element of patient autonomy is granted, such as examples from North America and Europe can show. If we have a medical cannabis system which is too tightly controlled then it will only serve to turn patients away from legitimate sources and into the existing, and rife, ‘black markets’.

So how are UK patients getting hold of cannabis?

We also need to be wary about demonising black markets, by which the definition is correct, but we must look at the full picture. Due to having a full prohibition model, the UK, of course, has a lot of cannabis on the streets, some of which will be controlled by organised crime groups. The practice of ‘county lines’ is now a problem that the general public is having to recognise. County lines is a new method of drug distribution – children are being used by organised crime groups and gangs to travel into small towns and sell drugs. This is a real threat and danger.

There is, however, another side of the coin. Not all illicit cannabis is sold by organised crime groups; there’s a lot of cannabis being produced, sold, swapped, and even given away by a network of activists and patients who have chosen to take matters into their own hands. There’s certainly an argument to be made that, despite being criminals by the letter of the law, such domestic networks of distribution have become a necessity for those who wish to obtain safe access to their cannabis, away from funding organised crime, and also ensure they know exactly what cannabis products they are consuming.

The term ‘skunk’ has become a catch-all slang term for high-potency cannabis composed of predominantly THC, but those who consume cannabis will be able to dismiss this terminology and provide a different explanation. Connoisseurs often like to vary their THC and CBD ratios, the two main components of cannabis.

There’s also been a rise in UK Cannabis Social Clubs (UKCSC), a system inspired by the Spanish Cannabis Social Club model whereby collectives come together, grow their cannabis under a tagged system which allows patrons to trace the lineage of the cannabis’ genetics, and then distribute the finished products within their selected club. This is a system based on collective responsibility and personal autonomy.

This particular model has received a lot of praise from several UK Police and Crime Commissioners who have seen firsthand how this model severs ties to crime, as well as safeguarding against child access – which of course street dealers often do not do. This social club model could well overlap into the medical cannabis conversation, allowing patients to socialise and have nuanced access to cannabis products.

Where will the debate go from here?

Within the last few weeks even more movement has taken place. Campaign group the United Patients Alliance (UPA), a group made up of patients who have varied health conditions, has long backed moves to reform medical cannabis and has been a loud voice in dialogue shaping reform. Announcing via its social media, the UPA had provided a summary to recent meetings which have taken place among a number of stakeholders: the Home Office has chosen to disband the expert panel which had been previously appointed to take on and individually assess the cases brought forward. Due to the tight restrictions, and with little development from the expert panel, many see this as a positive move.

Moving forward, clinical specialists will be able to apply for an import licence on behalf of their patients, with clinical guidelines expected to be proposed by NHS England in the interim period before official National Institute for Health and Care Excellence (NICE) guidelines are published at a later date. Over time it is expected that general practitioners may be able to prescribe cannabis.

There’s an emphasis, according to the UPA’s update, on the prohibitive nature of smoked products, with vaporisation expected to be an option. The health conditions most likely to receive attention under these various guidelines include: severe epilepsy, nausea in chemotherapy, and chronic pain.

The conversation around the UK and medical cannabis is not going to go away, it’s only set to get louder. We’re seeing more and more examples of medical bodies and patient support groups coming forward to lend their voice to the increasing calls for reform. The MS Society recently backed its patients who choose to use cannabis, and the Royal College of Nursing debated and passed a resolution which supported medical cannabis.⁵

Perhaps most notably, the British Medical Journal called for the reform and regulation of all drugs for the sake of public health.⁶ It’s fair to say that the medical cannabis debate is only the start. With patients and many politicians now in favour, as well as NGOs – all of whom are joining together to keep the momentum going – the UK Government is looking definitively out of touch at best and, at worst, increasingly hypocritical.

About LEAP UK

LEAP (Law Enforcement Action Partnership) UK brings together civilians, police officers, undercover operatives, members of the intelligence service, military personnel and a range of figures from the criminal justice system to raise awareness of the failed, dangerous and expensive pursuit of a punitive drug policy.

Its primary objective is to reduce the harmful consequences of current drug policies and to promote evidence-based, public health-centred policies for drugs and mental health.
Namely, LEAP UK aims to:

• Educate the public, media and policymakers on the failure of current drug policy by presenting a true picture of the history, causes and effects of drug abuse and prohibition-related crime, and
• Restore public respect for law enforcement, which has been lost by its involvement in imposing drug prohibition.

To this end, LEAP UK has created a constantly enlarging speakers bureau, staffed with knowledgeable and articulate former ‘drug warriors’ who describe the financial and human cost of current drug policies, and their impact on police/community relations, the safety of law enforcement officers and suspects, and police corruption and misconduct.

Editor’s note: This article was written before Home Secretary Sajid Javid announced that doctors will be able to prescribe cannabis products to patients from 1 November.

References

1. http://www.incb.org/documents/Narcotic-Drugs/TechnicalPublications/2017/7_Part_2_comments_E.pdf
2. https://www.unodc.org/unodc/en/treaties/single-convention.html
3. https://www.release.org.uk/law/schedules
4. https://www.gov.uk/government/news/new-expert-panel-set-up-to-advise-on-medinical-cannabis-licence-applications
5. https://www.rcn.org.uk/congress/agenda/cannabis
6. https://www.bmj.com/content/361/bmj.k2057

Jason Reed
Executive Director
LEAP UK
Tweet @UKLEAP
http://ukleap.org/

This article will appear in issue 7 of Health Europa Quarterly, which will be published in November 2018.